Provider Demographics
NPI:1548358302
Name:CASCO BAY REHABILITATION, PA
Entity type:Organization
Organization Name:CASCO BAY REHABILITATION, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-829-6009
Mailing Address - Street 1:335 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2363
Mailing Address - Country:US
Mailing Address - Phone:207-829-6009
Mailing Address - Fax:207-829-6022
Practice Address - Street 1:335 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2363
Practice Address - Country:US
Practice Address - Phone:207-829-6009
Practice Address - Fax:207-829-6022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEM123570OtherCIGNA
ME018123OtherANTHEM
ME154850000Medicaid
ME=========OtherAETNA
ME154850000Medicaid